Evaluation of cervical cancer screening services in Minia Governorate, Egypt

Transcription

1 Evaluation of cervical cancer screening services in Minia Governorate, Egypt Dr. Ahmad Sameer Sanad Assistant professor Obstet. & Gynecol, Minia University Minia, Egypt

2 Disclosures No financial relationships or conflict of interest to disclose

3 Aim of the work

4 The aim of this work was to study the prevalence of cervical cancer and its precursors at Minia governorate and to establish a program for cervical cancer screening using 3 5 % acetic acid (VIA) to visualize the cervix.

5 Introduction

6 Introduction Incidence of cervical cancer may be up to six times higher in developing countries than in developed countries due to lack of screening programs. Visual inspection by acetic acid (VIA) is naked-eye visualization (without magnification) of the acetic-acid-washed cervix (using diluted 3-5% acetic acid) to screen for cervical abnormalities, making identification of abnormal tissue easier.

7 Patients & Methods

8 Patients and methods The study protocol was approved by scientific ethical committee of the Department of Obstetrics and Gynecology, Faculty of Medicine, Minia University in May Approval was ascertained from the Institutional Review Board of the Faculty of Medicine; Minia University in June The approval then was sent to the Ministry of health and population, maternal and child health (MCH) department that agreed the protocol on August 2014.

9 Patients and methods Training program was convened in the Minia Maternity University Hospital by one of the staff members of MMUH and repeated 9 times for each health administration. Each training course lasted 3 days and included 15 physicians from one health administration. The 1st day of the training program was scientific lectures. The 2nd and 3rd days comprised practical training on VIA screening in the Early Cancer Detection Unit (ECDU).

10 Patients and methods For all Subjects, the followings were performed: Questionnaire addressing clinical and epidemiological risk factors for: Age, address, occupation, special habits and Husband's, duration of marriage, obstetric history (Parity and contraception), gynecological history, contraceptive history, sexual history pelvic examination without lubricant or antiseptic: Naked eye examination (erosion, ulcer, mass or polyp), Leukoplakia.

11 Patients and methods VIA setting: Reporting of the test outcome: Positive test: when there were sharp, distinct, well-defined, dense (opaque/dull or oyster white) acetowhite areas; with or without raised margins; close to the SCJ. Negative test: Negative diagnosis included normal cervix where squamous epithelium and the columnar epithelium remained pale, colorless. Doubt test: When in doubt, the test was repeated. The findings were noted in the reporting cards developed for the screened women.

12 Patients and methods Referral system: VIA-positive women were referred to the ECDU at MMUH. Result of examination declaring the (+ve) area of the cervix. Mapping of positive results on special graph of the cervix were done. Colposcopy was performed by the trained colposcopist.

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14 Patients and methods All women with suspected CIN and cancer had colposcopy-directed cervical biopsy and the specimens were fixed in 10% formalin, given to the women or their relatives for histopathology. Women without acetowhite lesions during the colposcopic evaluation were considered normal.

15 Results

16 Results Frequency distribution of primary health care units in Minia governorate District Urban units Rural units Minia 5 45 Samalout 1 58 Matay 2 20 Beni Mazar 1 42 Maghagha 2 39 El-Edwa 1 27 Abo-korkas 2 37 Malawy 2 47 Dermawas 2 23 Total 18 (100) 338

17 Results Feedback of the physician at the end of the training program: 191 (95.5%) of the physician said that the training is important and is needed 35 (17.5%) said they aren t interested in training 56 (2.8%) said that the place of training is so far 87 (43.5%) said that the training time is inappropriate 19 (9.5%) said that the training duration is short 18 (9%) said that they need to increase the time of clinical training 184 (92%) said that the screening test is easy and applicable. 173 (86.5%) said the people will refuse to do the screening by a male doctor

18 Comparison between positive and negative cases, according to residence Results Distribution of positive and negative cases, according to residence Urban units Rural units Total Positive Negative Total

19 Results All VIA positive women (156) were referred to ECDU, 18 (11.5%) women did not attend to unit while 138 (88.5%) women completed the evaluation process. Evaluation of (138) VIA positive women revealed 106 women were colposcopically free.

20 Results The remaining 32 women (1.1% of the total screened population) were reevaluated by biopsy and histopathological examination. Biopsy results showed that 25 women had low grade squamous intraepithelial lesions and 7 cases had high grade squamous intraepithelial lesions. Results Number Percentage LGSIL HGSIL

21 Results We were faced with the following problems Decrease in the number of PHC doctors, Rapid turnover of PHC doctors, Refusal of women to be examined with male doctors, Lack of interest of some residents, Absence of some doctors from training and lastly The screened positive women didn t attend to the ECDU at Minia MMUH

22 Results The following are trials to reduce the impact of these problems Explanation the importance of cervical cancer screening program and how it easy to be done, Use of mobile family planning units in the PHC unit and on job training Training of family planning nurses

23 Conclusions Cervical cancer screening program in developing countries is a major challenges The success of any screening program require national will Screening programs can be modulated and being malleable to respect the local traditions in each community.

24 THANK YOU